Mucosal Prolapse Polyp Mimicking Rectal Malignancy: A Case Report

Abstract

Mucosal prolapse polyps (MPPs) are rare inflammatory lesions that are part of the mucosal prolapse syndrome. We present the case of a 40-year-old male with history of constipation referred to our institution with suspected rectal malignancy due to hematochezia and a palpable rectal mass. Colonoscopy revealed a 25 mm wide lesion suggestive of subepithelial origin but with marked erythema and erosion in the mucosa. Crypt dilatation and distortion, mixed inflammatory infiltrate and fibrosis were apparent on histological evaluation after bite-on-bite biopsies. Due to the initial suspicion of malignancy, resection was decided after discussion with the patient. However, due to non-elevation partial resection was performed allowing the diagnosis of MPP. Hematochezia ceased after obstipation treatment and endoscopic follow-up showed maintenance of the lesion with the same characteristics except for reduced dimension. MPP may mimic neoplastic lesions and should be considered in the differential diagnosis of rectal masses. History, endoscopy and histological characteristics are all necessary and important in the diagnosis of MPP.

Rectal ischemia causes mass formation, masquerading as rectal cancer

“…Also, it is worth noting that atypical endoscopic image and other diseases, such as rectal syphilis and mucosal prolapsed syndrome, may mimic rectal cancer and should be include in differential diagnosis of an endoscopically likely rectal cancer [ 9 , 10 ].…”

Prolapsing mucosal fold: largest reported, presenting with major haemorrhage

“…Despite previous reports, PMFs are not always associated with diverticular disease, solitary rectal ulcer syndrome or rectal prolapse [ 5 ]. There are no reported cases where PMFs have evolved into adenomatous polyps or a precursor to colorectal cancer [ 1 ]. PMFs are more common in males (3:1) and typically present from 45 to 65 years old [ 4 ].…”

“…Prolapsing mucosal folds (PMFs) are uncommon benign colonic lesions that when inflamed may macroscopically resemble, and be confused with, an adenomatous or hyperplastic polyp [ 1 ]. Their aetiology is unclear [ 1 , 2 ].…”

“…Prolapsing mucosal folds (PMFs) are uncommon benign colonic lesions that when inflamed may macroscopically resemble, and be confused with, an adenomatous or hyperplastic polyp [ 1 ]. Their aetiology is unclear [ 1 , 2 ]. These lesions are often, but not always, associated with diverticular disease [ 2 , 3 ], solitary rectal ulcer syndrome or rectal prolapse [ 4 ].…”

“…These lesions are often, but not always, associated with diverticular disease [ 2 , 3 ], solitary rectal ulcer syndrome or rectal prolapse [ 4 ]. Most patients are asymptomatic but can present with gross or occult rectal bleeding, crampy abdominal pain or non-specific changes to bowel habits [ 1 , 4 ].…”